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General NPI Number Information
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NPI Number | 1740877026
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Entity Type | Organization
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Legal Business Name | LOOP PSYCHOTHERAPY, P.C.
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Dates
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Enumeration Date | 12/21/2020
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Last Update Date | 12/21/2020
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Provider Practice Location Address
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Address Line | 200 E RANDOLPH ST STE 5100
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City | CHICAGO
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State | IL
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Zip | 60601-6528
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Country | US
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Telephone | 773-517-5211
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Fax |
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Provider Business Mailing Address
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Address Line | 200 E RANDOLPH ST STE 5100
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City | CHICAGO
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State | IL
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Zip | 60601-6528
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | DR. DAVID BERKMAN
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Credential | PSYD
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Telephone | 773-517-5211
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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